Do I Need to Remove My Upper Wisdom Teeth?

You are trying to decide whether your upper wisdom teeth should come out or be left alone, and two clinicians may have told you different things.

The short answer is this: upper wisdom teeth are often left alone when they are fully erupted, easy to clean, and not harming the tooth in front. Upper wisdom teeth are more often removed when they are partly erupted, hard to clean, trapping decay, or causing damage nearby.

Upper wisdom teeth are not automatic extractions

Upper wisdom teeth do not always need extraction just because they exist. A healthy upper wisdom tooth can sometimes stay for years if it has enough space, lines up well enough to function, and can be cleaned.

Dentists and oral surgeons do not all agree on removing symptom-free wisdom teeth. Some prefer early removal if they expect trouble later, while others prefer watching a quiet tooth closely instead of operating now.

A second opinion can be reasonable when one clinician says remove them and another says leave them. The useful question is not "do upper wisdom teeth ever stay" but "what specific risk does this tooth pose in this mouth."

I'm in my 60s and still have my wisdom teeth. Having them all removed when you're young is a *very* recent development in dental practice. You're never going to convince me that all of a sudden evolution decided to create an entire generation of tiny jaws that all need thousands of dollars worth of oral surgery.

— r/AskReddit

A top wisdom tooth usually needs removal when it is damaging the tooth in front

An upper wisdom tooth becomes a stronger candidate for extraction when it is causing a real problem. The most common reasons are decay that cannot be cleaned, gum infection around a partly erupted tooth, biting trauma, or damage to the second molar in front.

Pain is not the only sign that matters. A tooth can be quiet but still collect plaque in a spot you cannot reach, or create a pocket between teeth where decay starts on the back of the second molar.

X-rays matter here because they show position, available space, and whether the second molar is at risk. If a clinician points to a cavity, bone loss, a trapped food area, or a cyst-like change, that is a clearer reason than "we always take wisdom teeth out."

Those upper ones will be impossible to clean once they come in, and they will cause issues with the teeth directly in front of them. Get rid of the 4 wisdom teeth, otherwise it might be 8 teeth that need to be extracted in 10-20 years

— r/askdentists

A symptom-free upper wisdom tooth may be left alone when it is fully erupted and maintainable

A symptom-free upper wisdom tooth may be left alone if it is fully erupted, reachable with a toothbrush, and not creating gum problems or decay on the tooth in front. Good contact with the opposite tooth also helps, because an unopposed tooth can over-erupt and become annoying.

Keeping upper wisdom teeth makes more sense when checkups and X-rays show stability over time. Stability means no repeated infection, no trapped flap of gum, no cavity you cannot restore well, and no hidden damage to the second molar.

Watching a tooth is not the same as ignoring it. A tooth that is being monitored still needs routine exams, and if the area becomes difficult to clean or starts damaging the neighbor, the decision can change.

Anyone know anything about the rumor that the widespread belief that everyone needs their wisdom teeth out is in large part a ploy for dentists to make money? I still have mine, but they also never caused me any trouble.

— r/AskReddit

Choose monitoring or extraction based on access, position, and risk

Upper wisdom teeth suit different plans depending on how they sit in the mouth. Monitoring suits the easy, stable tooth; extraction suits the tooth that is partly trapped, unhygienic, or already causing harm.

One useful difference is access. A fully erupted top wisdom tooth can be surprisingly manageable, while a partly erupted or tilted top wisdom tooth can stay plaque-covered even in someone who brushes well.

• Choose monitoring if the upper wisdom tooth is fully erupted, easy to brush, not hurting the gum, and not damaging the second molar.
• Choose extraction if the upper wisdom tooth is partly erupted, repeatedly inflamed, decayed, impossible to clean well, or linked to a problem on the tooth in front.
• Choose a second opinion if the advice feels routine rather than specific, or if one clinician recommends surgery without showing the reason on the exam or X-ray.

An oral surgeon may advise against extraction when surgery risk outweighs current benefit

An oral surgeon may advise against extraction when an upper wisdom tooth is quiet and the expected benefit is small. That can happen when the tooth is deeply embedded without signs of disease, sits close to structures that make surgery less straightforward, or belongs to someone with medical factors that raise procedure risk.

Older age can also change the balance. Healing and surgery tolerance vary from person to person, so the same X-ray may lead to different advice in a teenager than in someone decades older.

Plain disagreement does not always mean one clinician is wrong. One clinician may focus on future risk, while another may focus on avoiding a procedure unless there is active disease or clear damage now.

No, go see an oral surgeon. If the second molar is compromised, that's a different story. But horizontally impacted wisdom teeth are removed daily by oral surgeons

— r/askdentists

The best next step is to ask exactly why this upper wisdom tooth stays or goes

A useful consultation about upper wisdom teeth should end with a concrete reason, not a general rule. You should be shown whether the issue is decay, cleaning access, gum infection, damage to the second molar, an abnormal follicle, or lack of any current problem.

If the reason is unclear, ask what would make the recommendation change in either direction. That answer tells you whether the plan is based on your actual tooth or on a blanket habit.

If you have swelling, a bad taste, repeated infection, or a suspected cavity around the wisdom tooth or the tooth in front, book a dentist or oral surgeon visit rather than trying to guess from symptoms alone.

These absolutely need to come out. Leaving them in is just asking for problems. In particular, the one on your right (left side of the image) has an asymmetrically enlarged follicle (the dark space around it) and I would be concerned about cyst formation. Wisdom teeth surgery is much easier than you'd expect and future you will thank you for doing it.

— r/askdentists

Common questions

Do upper wisdom teeth need extraction if they do not hurt?

Not always. Pain is only one factor, and some upper wisdom teeth are left alone when they are fully erupted, easy to clean, and not harming the second molar. A quiet tooth still needs periodic checks because problems can stay hidden for a while.

How do I decide whether to remove top wisdom teeth or not?

Look for specific reasons, not a blanket rule. Removal makes more sense when the tooth is partly erupted, hard to clean, decayed, repeatedly inflamed, or damaging the tooth in front. Monitoring makes more sense when the tooth is stable, maintainable, and not causing disease.

Why would an oral surgeon advise against extraction?

An oral surgeon may think the current benefit is too small compared with the surgery. That can happen when an upper wisdom tooth is symptom-free, deeply embedded without signs of disease, or in a situation where the operation is less straightforward than simple removal. In those cases, watchful follow-up may be the better call.

Is upper wisdom tooth extraction necessary if another dentist said I can keep them?

It depends on what each clinician is seeing on the exam and X-ray. If one points to damage, trapped decay, gum infection, or a risky position, that is different from removing a tooth just in case. Ask both what exact finding supports their advice.

When are upper wisdom teeth usually left alone?

Upper wisdom teeth are often left alone when they are fully erupted, cleanable, symptom-free, and not affecting the second molar or gum around them. They are also more likely to be monitored when they have stayed stable over time. Keeping them does not mean forgetting them at checkups.

Start by getting the reason in plain words and on the X-ray: is this upper wisdom tooth harming anything, hard to maintain, or simply present. If nobody can show a clear problem, monitoring is often a reasonable path.

If the explanations still clash, get one focused second opinion from a dentist or oral surgeon and ask what finding would make them change their advice. That usually clears up whether you are choosing between two valid approaches or between a specific plan and a routine habit.